Variability of Surgical Site Infection With VEPTR at Eight Centers: A Retrospective Cohort Analysis

Garg, Sumeet; Cyr, Micaela; Hilaire, Tricia St.; Flynn, Tara; Carry, Patrick M.; Glotzbecker, Michael P.; Smith, John T.; Sawyer, Jeffrey R.; Pahys, Joshua M.; Luhmann, Scott J.; Flynn, John M.; El-Hawary, Ron; Vitale, Michael G.

doi:10.1016/j.jspd.2015.07.009

Cited by 24 publications

(15 citation statements)

References 28 publications

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“…Such a discrepancy is very confusing. Garg et al [ 37 ] identified only wound complications following VEPTR implant or revision surgeries. If so, adding implant, alignment, and medical-related complications, the final percentage of complications should be expected at a much higher level.…”

Section: Discussionmentioning

confidence: 99%

Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review

Latalski¹,

Fatyga²,

Sowa³

et al. 2021

WJO

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BACKGROUND The treatments for early-onset scoliosis (EOS), defined as curvature of the spine with onset before 10 years of age, continue to pose a great challenge for pediatric orthopedics. The treatment goals for EOS include minimizing spinal deformity while maximizing thoracic volume and pulmonary function. Different surgical techniques have different advantages and drawbacks; however, the two major concerns in the management of EOS are repeated surgeries and complications. AIM To review the current literature to assess the safety of EOS surgical treatment in terms of the rate of complications and unplanned surgeries. METHODS In January 2021 two independent reviewers systematically searched three electronic medical databases (PubMed, the Cochrane Library, and Embase) for relevant articles. Every step of the review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Due to the heterogeneity of articles and topics after data analysis, a descriptive (synthetic) analysis was performed. RESULTS A total of 2136 articles were found. Forty articles were included in this systematic review, after applying our inclusion and exclusion criteria. EOS surgery has a varying but high rate of complications. The most frequent complications were categorized as implant (54%), general (17%), wound (15%) and alignment (12%). The rate of complications might have been even higher than reported, as some authors do not report all types of complications. About 54% of patients required unplanned surgeries due to complications, which comprised 15% of all surgeries. CONCLUSION The literature concerning the definitions, collection, and interpretation of data regarding EOS surgery complications is often difficult to interpret. This creates problems in the comparison, analysis, and improvement of spine surgery practice. Additionally, this observation indicates that data on the incidence of complications can be underestimated, and should be interpreted with caution. Awareness of the high rate of complications of EOS surgery is crucial, and an optimal strategy for prevention should become a priority.

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Section: Discussionmentioning

confidence: 99%

Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review

Latalski¹,

Fatyga²,

Sowa³

et al. 2021

WJO

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“…VEPTR hardware infections have been reported in the literature to occur in 1.5 to 24 percent of patients. 2,11,12,[23][24][25] Theoretically, muscle flaps have demonstrated resilience when used over an infected wound bed, [26][27][28][29] because they have better bactericidal activity than random skin and fascial flaps as a result of their superior perfusion facilitating delivery of antibiotics, nutrients, leukocytes, and other inflammatory response mediators to the devitalized area. 26,28 Muscle flaps demonstrate rapidly increasing blood flow to the muscle within the first 24 hours, whereas fascial flaps demonstrate a slow gradual increase over several days.…”

Section: Surgical Factorsmentioning

confidence: 99%

Surgical and Nonsurgical Factors Associated with Salvaging Exposed Vertical Expandable Prosthetic Titanium Rib Hardware

Kalmar

Zapatero

Lott

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Vertical expandable prosthetic titanium rib (VEPTR) devices were designed to treat childhood scoliosis and thoracic insufficiency syndrome. Although they have drastically reduced patient mortality, they present a profound subcutaneous hardware burden. The authors examined the surgical and nonsurgical factors associated with salvage of VEPTR hardware exposures. Methods: Between 2014 and 2020, a prospective institutional database was queried for patients with VEPTR hardware complications who required soft-tissue reconstruction. Hardware salvage was considered successful if reconstruction allowed the hardware to be retained until the next VEPTR expansion. Results: Fifty-eight patients required VEPTR hardware salvage. Hardware complications were successfully salvaged in 62.1 percent of patients at 60.0 percent of operative sites. Neuromuscular scoliosis (p = 0.041) and nonambulatory status (p = 0.018) were factors associated with VEPTR hardware salvage failure, whereas congenital scoliosis was associated with successful hardware salvage (p = 0.012) and preventing need for immediate hardware removal (p = 0.049). Exposed hardware, as compared to threatened exposure, was more likely to require immediate removal (p = 0.045) and result in unsuccessful hardware salvage (p = 0.015). Conclusions: Local and regional muscle flaps were able to prevent VEPTR hardware removal in the majority of patients, even in the setting of infection, immobility, incontinence, and multiple systemic comorbidities. Patients with neuromuscular scoliosis and nonambulatory status were at increased risk for failure, whereas those with incontinence and low body mass index trended toward increased risk of failure. Threatened exposure was associated with higher rates of salvage than exposed hardware, and thus earlier referral to plastic surgeons for soft-tissue salvage may be advised. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

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“…Since the year 2000, the reported risk of SSI in pediatric spine surgery ranges from 0% to 26.3% in the USA. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Most of these studies have found that patients with non-idiopathic deformities, including cerebral palsy (CP), are at increased risk of SSI compared with those with idiopathic etiologies. 1,3,4,16 Treatment of SSI entails surgical irrigation and debridement of the wound (often multiple), long-term antibiotic treatment/suppression, and possibly implant removal or revision.…”

mentioning

confidence: 99%

“…Surgical site infection (SSI) after pediatric spine surgery is a well‐recognized complication. Since the year 2000, the reported risk of SSI in pediatric spine surgery ranges from 0% to 26.3% in the USA 1–18 . Most of these studies have found that patients with non‐idiopathic deformities, including cerebral palsy (CP), are at increased risk of SSI compared with those with idiopathic etiologies 1,3,4,16 .…”

mentioning

confidence: 99%

A novel risk calculator predicting surgical site infection after spinal surgery in patients with cerebral palsy

Matsumoto

Franzone

Sinha

et al. 2022

Develop Med Child Neuro

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Surgical site infection (SSI) after pediatric spine surgery is a well-recognized complication. Since the year 2000, the reported risk of SSI in pediatric spine surgery ranges from 0% to 26.3% in the USA. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Most of these studies have found that patients with non-idiopathic deformities, including cerebral palsy (CP), are at increased risk of SSI compared with those with idiopathic etiologies. 1,3,4,16 Treatment of SSI entails surgical irrigation and debridement of the wound (often multiple), long-term antibiotic treatment/suppression, and possibly implant removal or revision. This all results in a substantial burden to patients, families, physicians, hospitals, and payers. 19,20 While the literature documents multiple

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Variability of Surgical Site Infection With VEPTR at Eight Centers: A Retrospective Cohort Analysis

Abstract: III, therapeutic study.

Cited by 24 publications

References 28 publications

Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review

Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review

Surgical and Nonsurgical Factors Associated with Salvaging Exposed Vertical Expandable Prosthetic Titanium Rib Hardware

A novel risk calculator predicting surgical site infection after spinal surgery in patients with cerebral palsy

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